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[Music]

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{Applause.}

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Thank you. It's truly an honor to be here.

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I would like to start my talk today with a little exercise,

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introducing you to a person named Pat.

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Pat is 31 years old and lives at home with one sibling and their parents.

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Pat has always lived in the family home.

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And would not consider moving out to live alone.

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Except after getting married.

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Pat's parents always play a significant role

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in making decisions about all aspects of Pat's life

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including education, work decisions, Pat's friendships and romantic life.

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This has been the case since Pat was a child.

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Pat rarely makes decisions without consulting family members

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and rarely expresses disagreement with others

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out of fear of disapproval or loss of support.

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Pat feels very uncomfortable when alone

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and tends to cling to others out of fear of being abandoned.

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Now take a moment to picture Pat.

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Are you picturing a young man?

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A young woman?

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Are you picturing a person of a particular ethnic or cultural background.

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Maybe similar to your own. Or different.

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And consider for a moment whether such information

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would make a difference in how you think about Pat

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and whether or not you think that Pat might have some kind of mental health concern.

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Now what if I added the following information.

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Specifying that Pat is Patricia Lee

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and that she and her family immigrated to Canada from China

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when she was five years old.

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Or the following.

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Where Pat is Patrick Smith whose maternal and paternal grandparents

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immigrated to Canada from the United Kingdom and whose parents grew up in the Toronto area.

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Judging from some faces that I can see,

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this information indeed makes a difference in how you think about Pat.

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Simply adding some basic demographic information,

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can significantly shift how we think about the very same behaviors.

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This exercise has elicited similar responses in my classroom

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when I have used it in teaching about personality disorders,

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which offer a particularly striking example

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of the need to consider cultural factors when defining mental illness,

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since they are themselves defined by patterns of behavior that deviate from cultural expectations.

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I use this exercise to introduce the role of cultural factors

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in thinking about mental health and illness

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and to introduce the central idea that culture matters.

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In my experience, once introduced to this idea,

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people seem to intuitively know that culture

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makes a difference when thinking about mental health and mental illness.

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Without specifically talking about cultural differences

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in things like parent-child relationships, independence and interdependence,

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or assertiveness,

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we seem to just know that it makes a difference if we're talking about Patricia or Patrick.

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But not only does culture matter when it comes to mental health, it is fundamental.

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Many people including myself argue

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that a culturally informed approach is really critical to effective healthcare.

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And that only by including cultural factors in our discussions of this field

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will we truly make advances.

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Recently a group of medical and social scientists

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writing in one of the world's most prestigious medical journals,

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stated the following:

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That the systematic neglect of culture in health and healthcare

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is the single biggest barrier to the advancement of the highest standard of health worldwide.

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A pretty powerful statement. So this is great.

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I see a number of you nodding and you seem to be in agreement

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that reflecting on Pat illustrates for you at least at a basic level

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the importance of considering cultural questions when it comes to mental health.

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But stopping here would be problematic for a number of reasons.

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First of all I still have 15 minutes and 52 seconds left on the clock.

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But more importantly,

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stopping here could serve to reinforce certain cultural stereotypes.

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Contrasting the Lees versus the Smiths.

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And would not really leave you with any idea of how to actually

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go about considering cultural factors.

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Or worse, it might leave you with an overly simplistic idea of how to do this.

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Suggesting perhaps that simply knowing a person's ethnic background

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or immigration history provides enough information

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to really understand the meaning of their behaviors and relationships.

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So acknowledging that culture matters is a crucial initial step,

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sort of like the first piece of a puzzle.

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But we need to go much further.

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So if knowing Pat's cultural background

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is like having a first piece of the puzzle, much more

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needs to be learned before getting even close to a complete picture.

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For example, based on common cultural ideas,

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you may have had the sense that the description of Pat's behavior

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became somehow more acceptable when it was Patricia.

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A young woman of Chinese-Canadian background.

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Compared to Patrick, a young man and second generation Canadian of British descent.

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However, although interdependence and social harmony

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are values more commonly endorsed among people of Chinese background

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compared to western European background,

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is it necessarily the case that Patricia's parents are happy with her level of dependence on them?

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Maybe their migration to Canada was driven by their own traits of independence.

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And they are really quite concerned that their daughter

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has not developed greater autonomy or self-reliance.

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Maybe Patricia has never felt that she fits in among her peers

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and really feels incapable of attaining the level of independence as encouraged by her parents.

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On the other hand, although independence and autonomy

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are commonly endorsed values in North America,

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maybe it's normative within Patrick's family

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to defer to one's parents and to view life decisions as communal endeavors.

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These examples illustrate that we cannot simply make sweeping assumptions

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about people purely based on their cultural background,

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nor can we make simple comparisons or distinctions between people

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simply because they're from different contexts.

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Now this might suggest to you then that cultural information is of not much use at all

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and that we should simply focus on the individual and their unique experiences.

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But this would also be problematic and incomplete

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because to truly understand Patricia Lee's experience

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we must know that her parents' level of emphasis on independence may be relatively uncommon --

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uncommon within their cultural community.

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And on the other hand, or similarly,

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Patrick Smith's experience of his level of dependence upon his family

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would likely carry different meaning if he and his family

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were from a cultural community that particularly emphasized family bonds.

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So in other words, in order to really develop a full understanding of mental health,

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we must develop an understanding of individuals in context.

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So this discussion illustrates one of the key challenges of a culturally informed approach to mental health.

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And in teaching this field to undergraduate students

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I have the privileged opportunity of working with them as they wrestle with these varied types of challenges.

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The path that I often see my students take is one of initial excitement

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as they engage with the idea that culture matters

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and often tend to appreciate the indepth discussion of a topic

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that tends to be lacking or minimized in teachings about mental health.

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This initial excitement, though, then turns often to some level of feeling overwhelmed

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as they begin to really grapple with the complexity of culture

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and begin to recognize the number of different factors to consider and questions to pose.

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In helping my students to navigate these questions

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it has helped me to distill my own thinking about this field

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and how best to teach it.

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I recognize that dealing with cultural matters can indeed be daunting.

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And I also have the concern that feeling overwhelmed can sometimes lead to the avoidance of new ideas or experiences.

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So with that in mind,

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I propose two related suggestions that I believe can help people to engage

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with a culturally informed approach to mental health

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rather than avoid it. And these are to take a stance of informed curiosity,

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and to ask different questions and ask questions differently.

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So a stance of informed curiosity stands in contrast

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to some models of culture and mental health

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which suggests that one needs to be an expert in a particular cultural group

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in order to work with or understand the experiences of a member of that group.

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For example many articles and book chapters

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talk about working with Asian clients or working with Hispanic clients.

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Although well intentioned, that type of approach

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can inadvertently lead to the perpetuation of cultural stereotypes.

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There's the assumption, at least at some level,

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that members of a given group share values,

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beliefs and experiences simply based on group membership.

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Though that can be the case, it is certainly not necessarily true.

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A clinician working from such a perspective

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may have easily assumed that Patricia Lee's level of dependence

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upon her family was encouraged or supported.

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I have also always found the more expertise based approach

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problematic from a personal perspective.

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As the daughter of a Chinese-Canadian father and Anglo-Canadian mother,

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born and raised in bilingual Montreal with English as a first language,

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there is unlikely to ever be a book chapter devoted

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to working with people of my particular cultural makeup.

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I think my own lived experience as a person of mixed cultural heritage,

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informs my thinking about culture and how it plays a role in mental health.

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And my experience also plays a role in my emphasis

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on a stance of informed curiosity rather than expertise.

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I believe that such a stance promotes an attitude of humility

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and really encourages one to develop hypotheses

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and questions rather than make assumptions.

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So one of the key ways that I work to promote a stance of informed curiosity

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among my students is by helping them to ask different questions

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and ask questions differently about mental health.

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My own passion for the area of culture and mental health really began

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when I took a course, an introductory course in medical anthropology

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in the second year of my undergraduate studies.

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This course proved to be a key turning point

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in my academic path and looking back,

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I think that one of its lasting effects

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was that it forced me to ask different questions about health and mental health,

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questions to which I had not previously been exposed in my psychology courses.

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Working with a different discipline,

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with its own set of theories and frameworks also instilled in me the value of asking questions differently.

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In many ways that forced me to re-evaluate ideas I had previously taken for granted.

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And that type of experience is often at the heart of cultural discussions about mental health.

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The interdisciplinary nature of my early experience also corresponds to the interdisciplinarity

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that often characterizes discussions of culture and mental health.

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Thinking back to that image of the complex set of puzzle pieces,

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a cultural approach to mental health truly benefits from the integration of different perspectives.

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Each offering their own sets and types of questions.

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Now taking a stance of informed curiosity

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by no means minimizes the importance of developing indepth knowledge in cultural matters.

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Rather, the emphasis is on how to engage with this knowledge

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with a focus really on gaining awareness

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of the wide range of cultural differences that exist in human experience.

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So as to be equipped to pose informed questions.

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We know from cultural psychology research

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that there are significant cultural differences

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across the spectrum of psychological domains.

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Including in cognitive and perceptual processes

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regarded as basic and therefore often assumed to be universal.

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For example, we know that there are significant cultural differences

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in how people perceive the world such as to what extent they focus on background information

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when examining a photograph, versus focusing on the photograph's central figure.

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We also know that there are significant differences

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in how people think about the world such as to what extent they use contextual information

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when grouping different objects together.

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These types of differences suggest that some of you may be viewing

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the slide behind me as a single wholistic image

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whereas others may be more focused on specific constituent parts.

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More directly relevant to mental health,

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we also know that cultural context plays a profound role

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in what types of emotions people most value

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and want to feel and how and with whom they express those emotions.

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In some cultural contexts,

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feeling proud is closely associated with generally feeling good.

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Whereas in other contexts the individual focus that pride entails

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makes it less desirable and there is a large literature demonstrating important cultural differences

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in how people define the very notion of the self.

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For some, the self is truly an autonomous and individual entity whereas for others,

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their ideas about the self include close interpersonal connections.

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So cultural differences in domains such as these

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should directly inform our thinking about mental health and illness.

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If culture plays such a profound role when things are going right,

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it must surely play a similar role when things go awry.

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How people experience profound shifts in their emotional life

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is deeply influenced by their values and beiefs about emotions

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and when and with whom it is appropriate to share their emotions.

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In some cultural contexts, physical symptoms of major depression

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tend to be more strongly emphasized compared to psychological symptoms.

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And this may be linked to cultural differences in values about emotions.

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So at this point, I have likely convinced you of a number of the challenges

0:15:21.257,0:15:24.367
of taking a culturally informed approach to mental health

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and I have offered some suggestions about how to engage with these challenges.

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But hopefully I have also at least planted the seed that there are rewards to be had as well.

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Not surprisingly I personally believe that the rewards at the level of research,

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clinical care and teaching about mental health are numerous and profound.

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And ultimately far outweigh the challenges.

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At a research level, in order to build a comprehensive understanding of mental illness,

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we must integrate cultural factors.

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As suggested by the quote near the start of my talk,

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"We neglect culture at our own peril."

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If what it means to be sad and to share this sadness with others,

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is profoundly impacted by our values and beliefs about emotion,

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then we will never develop a complete understanding of severe sadness

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or depression without a cultural approach.

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From a clinical perspective,

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integrating cultural factors into our assessment of a person's distress

0:16:27.328,0:16:33.598
is crucial to really understand their experience and can contribute to improved treatment.

0:16:34.173,0:16:39.513
We know from research that treatments that integrate a person's own cultural beliefs

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about the causes of their distress are more effective than treatments that do not.

0:16:45.974,0:16:49.324
How best to integrate cultural factors into treatment

0:16:49.324,0:16:52.564
is an area of ongoing investigation and debate

0:16:53.057,0:16:57.467
but begins with the argument that culture makes a difference.

0:16:58.728,0:17:01.998
And thirdly at the level of learning about mental health,

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for students and the general public more broadly,

0:17:05.218,0:17:10.296
the rewards of a culturally informed approach include greater open mindedness,

0:17:10.870,0:17:16.290
increased understanding of experiences different from one's own and less stereotyping.

0:17:16.763,0:17:22.873
This approach also offers new perspectives about ideas already learned about mental health.

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These are all rewards that my own students have specifically talked about

0:17:27.392,0:17:30.932
when discussing the benefits of learning about this field.

0:17:32.122,0:17:37.142
So my hope then for today is that you walk away with some of this increased open mindedness,

0:17:37.142,0:17:42.332
curiosity, and an interest in asking different questions about mental health,

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all rooted in the central premise that culture matters.

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Thank you.

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{Applause.}. [br]